| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $242 | $121 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $409 | $204.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $247 | $123.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $305 | $152.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $567 | $283.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $474 | $237 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $933 | $466.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,629 | $814.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,449 | $1,224.5 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,179 | $1,589.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,804 | $1,402 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,688 | $844 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,333 | $666.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,535 | $1,267.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,293 | $1,146.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,956 | $1,478 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,697 | $1,848.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,124 | $2,062 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $520 | $260 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $369 | $184.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,644 | $822 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,169 | $1,084.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,608 | $1,304 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,361 | $1,680.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,337 | $2,168.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $495 | $247.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,882 | $941 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,814 | $907 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,738 | $869 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,188 | $1,594 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,116 | $1,558 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,104 | $1,552 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,044 | $1,522 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,128 | $2,064 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,127 | $2,063.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,697 | $848.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,274 | $1,137 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $666 | $333 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $656 | $328 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $634 | $317 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,948 | $1,474 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,882 | $2,941 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $612 | $306 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $386 | $193 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $5,864 | $2,932 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,205 | $3,602.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,621 | $810.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,253 | $1,126.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,633 | $1,316.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,816 | $1,408 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,489 | $1,744.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,775 | $1,887.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,924 | $1,462 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,741 | $1,870.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,295 | $647.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $811 | $405.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,058 | $529 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $594 | $297 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,490 | $745 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $469 | $234.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,040 | $520 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,025 | $512.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,027 | $513.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $590 | $295 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $2,128 | $1,064 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $943 | $471.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $560 | $280 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,381 | $1,190.5 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | — | — | — | — | — |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | — | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | — | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | — | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | — | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | — | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | — | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | — | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | — | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | — | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | — | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | — | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | — | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | — | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $76 | $38 | — | — | — |
| General health panel | CPT | 80050 | 0 | $402 | $201 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $63 | $31.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $125 | $62.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $78 | $39 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $74 | $37 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $30 | $15 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $48 | $24 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $44 | $22 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $105 | $52.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $182 | $91 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $100 | $50 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $74 | $37 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $74 | $37 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $89 | $44.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $2,688 | $1,344 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,118 | $559 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $9,417 | $4,708.5 | — | — | — |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 0 | — | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $145 | $72.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $144 | $72 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $145 | $72.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $144 | $72 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $145 | $72.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $144 | $72 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $145 | $72.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $145 | $72.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $5,308 | $2,654 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $3,913 | $1,956.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,363 | $1,181.5 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $4,223 | $2,111.5 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $4,223 | $2,111.5 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $6,703 | $3,351.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $4,843 | $2,421.5 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $49,495 | $24,748 | — | — | — |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 0 | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $31,034 | $15,517 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $23,080 | $11,540 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $28,500 | $14,250 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $55,284 | $27,642 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $4,395.33 | $2,197.67 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $35,108 | $17,554 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $10,426 | $5,213 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $26,768 | $13,384 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $14,546 | $7,273 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $22,533 | $11,267 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $16,466 | $8,233 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $35,351 | $17,676 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $30,489 | $15,245 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $14,866 | $7,433 | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | — | — | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | — | — | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | — | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $2,886 | $1,443 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $6,438 | $3,219 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $26,537 | $13,269 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $23,542 | $11,771 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $7,667 | $3,833.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $12,929 | $6,464.5 | — | — | — |